- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $18,815.00 / $29,387.10
| Facility | | $4,804.00 | $18,815.00 | $29,387.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $3,027.00 / $19,277.80
| Facility | | $688.00 | $3,027.00 | $19,277.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,130.03 / $18,058.75 / $31,341.94
| Facility | | $11,130.03 | $18,058.75 | $31,341.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,814.00 / $40,616.60 / $40,616.60
| Facility | | $24,814.00 | $40,616.60 | $40,616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,402.00 / $16,203.75 / $31,341.94
| Facility | | $11,402.00 | $16,203.75 | $31,341.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,055.57 / $14,518.56 / $33,058.24
| Facility | | $5,055.57 | $14,518.56 | $33,058.24 |